Peripheral Lung Lesion Clinical Trial
Official title:
Predictive Diagnostic Criteria for Diagnosis of Transbronchial Biopsies, Echo-guided by Mini-probe in Peripheral Lung Lesions
The diagnosis of nodules and peripheral lung masses (lesions not accessible in classical
bronchial endoscopy) is a challenge for the pulmonologist especially when these lesions are
not accessible to the transparietal aspirate under scanner. The overall sensitivity of
flexible fibroscopy for peripheral lesions is 69% (bronchial brushing, transbronchial
biopsies, bronchoalveolar lavage and blind trans-mucosal aspiration). This sensitivity varies
from 33% when the lesion is less than 2 cm, to 62% when it is greater than 2 cm. The puncture
under scan of these lesions remains the gold standard. In the meta-analysis of Schreiber G et
al., The diagnostic sensitivity of transparietal aspirate for peripheral lung lesions is 90%.
On the other hand, the complication rate of this technique is not negligible, with in the
study of Boskovic et al, a pneumothorax rate varying from 8 to 64%. In the literature, the
only risk factor actually found is the existence of emphysema. However, thoracic drainage is
rarely necessary.
Bronchial echo-endoscopy using a radial mini-probe was developed in 1992 by Thomas Hürter and
Peter Hanrath to produce ultrasound guided specimens of these peripheral lung lesions. In the
meta-analysis of Steinfort et al., The overall sensitivity of this mini-probe technique is
73% for the histological diagnosis. From the same author, a randomized trial compared the
diagnostic sensitivity of transparietal aspirate undergoing ultrasound-guided transbronchial
biopsy with a radial mini-probe: this was 93.3% versus 87.5% with no significant difference
(p = 1 ), Whereas post-procedure complications are less frequent in the ultrasound procedure
(27% versus 3%, p = 0.03). Steinfort also showed that the economic cost of bronchial
echo-endoscopy by radial mini-probe and transthoracic puncture under CT was similar both to
the success or failure of the first procedure requiring further investigations .
Mini-probe-guided specimens are therefore an efficient diagnostic alternative to obtain a
histological diagnosis of these peripheral lung lesions
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